Using Independent Contracting Arrangements in Integrated Care Programs for Older Adults: Implications for Clients and the Home Care Workforce in a Time of Neoliberal Restructuring

Abstract

Integrated care programs reshape the processes of health and social care delivery in the home care sector to be more continuous, cooperative, equitable, and efficient. An independent contracting model is one approach being used to overcome issues related to home care fragmentation. To better understand the implications of this model of service delivery for clients and carers, interviews were conducted in 2013 with 22 key informants. Data were analyzed using thematic analysis and interpreted using a feminist political economy framework. This study finds that independent contracting arrangements improve care continuity for clients while simultaneously reinforcing precarious working conditions for home care workers. This research calls for reform to this model of service delivery to better support home care workers as they provide the care necessary for older adults to age in place.

Keywords

access to care health services home and community based care and services qualitative methods successful aging

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References

Armstrong

Connelly

(1989). Feminist political economy: An introduction. Studies in Feminist Political Economy, 30(1), 5–12. https://doi.org/10.1080/19187033.1989.11675504

Armstrong

Day

(2017). Wash, wear, and care: Clothing and laundry in long-term residential care. McGill-Queen’s University Press.

Baines

(2006). Whose needs are being served? Quantitative metrics and the reshaping of social services. Studies in Political Economy, 77, 193–207.

Baines

(2010). Neoliberal restructuring, activism/participation, and social unionism in the nonprofit social services. Nonprofit and Voluntary Sector Quarterly, 39(1), 10–28. https://doi.org/10.1177/0899764008326681

Baines

Daly

(2015). Resisting regulatory rigidities: Lessons from front-line care work. Studies in Political Economy, 95(1), 137–160. https://doi.org/10.1080/19187033.2015.11674949

Banerjee

Armstrong

Daly

Armstrong

Braedley

(2015). Care workers don't have a voice: Epistemological violence in residential care for older people. Journal of Aging Studies, 33, 28–36. https://doi.org/10.1016/j.jaging.2015.02.005

Berglund

Wilhelmson

Blomberg

Dunér

Kjellgren

Hasson

(2013). Older people’s views of quality of care: A randomized controlled study of continuum of care. Journal of Clinical Nursing, 22(19/20), 2934–2944. https://doi.org/10.1111/jocn.12276

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

Canada

C. P

(2021). Chief public health officer's report on the state of public health in Canada 2021. Public Health Agency of Canada.

10.

Coleman

Austin

Brach

Wagner

(2009). Evidence on the chronic care model in the new millennium. Health Affairs, 28(1), 75–85. https://doi.org/10.1377/hlthaff.28.1.75

11.

Day

Armstrong

Dans P.

Braedley

(2013). The implications of conceptualizing care. In Troubling care: Critical perspectives on research and practices (pp. 21–32). Canadian Scholars' Press Inc.

12.

Dubuc

Bonin

Tourigny

Mathieu

Couturier

Tousignant

, et al (2013). Development of integrated care pathways: Toward a care management system to meet the needs of frail and disabled community-dwelling older people. Int J Integr Care, 13, 2–13. https://doi.org/10.5334/ijic.976

13.

Etikan

Musa

Alkassim

(2016). Comparison of convenience sampling and purposive sampling. American Journal of Theoretical and Applied Statistics, 5, 1–4. https://doi.org/10.11648/j.ajtas.20160501.11

14.

Fereday

Muir-Cochrane

(2006). Demonstrating rigor using thematic analysis: A hybrid approach of inductive and deductive coding and theme development. International Journal of Qualitative Methods, 5(1), 1–11. https://doi.org/10.1177/160940690600500107

15.

Forum of Federal/Provincial/Territorial Ministers Responsible for Seniors (2012). Thinking about Aging in place. Gatineau, QC: Human resources and skills development Canada. Récupéré sur https://www.canada.ca/en/employment-social-development/corporate/seniors/forum/aging.html

16.

Fusch

Ness

(2015). Are we there yet? Data saturation in qualitative research. Qualitative Report, 20(9), 1408–1416.

17.

Gröne

Garcia-Barbero

(2001). Integrated care: A position paper of the WHO European office for integrated health services. International Journal of Integrated Care, 1(2), 1–10.

18.

Harris

Greaves

Patterson

Jones

Pappas

Majeed

, et al (2012). The North West London integrated care pilot: Innovative strategies to improve care coordination for older adults and people with diabetes. The Journal of Ambulatory Care Management, 35(3), 216–225. https://doi.org/10.1097/jac.0b013e31824d15c7

19.

Janse

Huijsman

de Kuyper

Fabbricotti

(2016). Delivering integrated care to the frail elderly: The impact on professionals’ objective burden and job satisfaction. International Journal of Integrated Care, 16(3), 1–13. https://doi.org/10.5334/ijic.2014

20.

Lin

Wang

Chen

Liao

Kao

(2009). To evaluate the effectiveness of a discharge-planning programme for hip fracture patients. Journal of Clinical Nursing, 18(11), 1632–1639. https://doi.org/10.1111/j.1365-2702.2008.02695.x

21.

Luxton

Braedley

Dans S.

Luxton

(2010). Doing neoliberalism: Perverse individualism in personal life. In Neoliberalism and everyday life (pp. 163–183). McGill-Queen’s University Press.

22.

Mitchell

Marston

Katz

Dans

Mitchell

M. K.

(2004). Life’s work: An introduction, review and critique. In Life’s work geographies of social reproduction. Blackwell Publishing.

23.

Montenegro

Holder

Ramagem

Urrutia

Fabrega

Tasca

Gomes

Salgado

Angelica Gomes

(2011). Combating health care fragmentation through integrated health service delivery networks in the Americas: Lessons learned. Journal of Integrated Care, 19(5), 5–16. https://doi.org/10.1108/14769011111176707

24.

Nolte

Knai

Hofmarcher

Conklin

Erler

Elissen

, et al (2012). Overcoming fragmentation in health care: Chronic care in Austria, Germany and The Netherlands. Health Economics, Policy and Law, 7(1), 125–146. https://doi.org/10.1017/s1744133111000338

25.

Ren

(2005). Modes of governance in neoliberal capitalism: An introduction. Rhizomes: Cultural Studies in Emerging Knowledge, 10.

26.

Singer

Burgers

Friedberg

Rosenthal

Leape

Schneider

(2011). Defining and measuring integrated patient care: Promoting the next frontier in health care delivery. Medical Care Research and Review, 68(1), 112–127. https://doi.org/10.1177/1077558710371485

27.

SMILE Program (2010). Eligibility criteria for the SMILE program. VON Canada.

28.

SMILE Program. (n.d . SMILE program since august 2008 brochure. VON SMILE Regional Management Centre.

29.

Snow

Galaviz

Turbow

(2020). Patient outcomes following interhospital care fragmentation: A systematic review. Journal of General Internal Medicine, 35(5), 1550–1558. https://doi.org/10.1007/s11606-019-05366-z

30.

Steger

Roy

(2010). Neoliberalism: A very short introduction. Oxford University Press.

31.

Thomas

Braedley

Dans S.

Luxton

(2010). Neoliberalism, racialization, and the regulation of employment standards. In Neoliberalism and everyday life (pp. 68–89). McGill-Queen’s University Press.

32.

Tsasis

Evans

Owen

(2012). Reframing the challenges to integrated care: A complexadaptive systems perspective. International Journal of Integrated Care, 12(5), 1–11. https://doi.org/10.5334/ijic.843

33.

Vivintel (2021). National home modification survey. March of dimes Canada.

34.

Vosko

MacDonald

Campbell

Vosko

Dans L.

MacDonald

Campbell

(2009). Gender and the concept of precarious employment. In Gender and the contours of precarious employment (pp. 1–25). Routledge.

35.

You

Dunt

Doyle

Hsueh

(2012). Effects of case management in community aged care on client and carer outcomes: A systematic review of randomized trials and comparative observational studies. BMC Health Services Research, 12(1), 395. https://doi.org/10.1186/1472-6963-12-395

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